The value of red blood cell distribution width, neutrophil-to-lymphocyte ratio, and hemoglobin-to-red blood cell distribution width ratio in the progression of non-small cell lung cancer

PLoS One. 2020 Aug 24;15(8):e0237947. doi: 10.1371/journal.pone.0237947. eCollection 2020.

Abstract

Background: Lung cancer is the leading cause of cancer-related deaths worldwide, with non-small cell lung cancer (NSCLC) accounting for 85% of all lung cancer cases. Inflammation has been proven to be one of the characteristics of malignant tumors. Chronic inflammatory response mediated by cytokines in the tumor microenvironment is an important factor in tumorigenesis. The purpose of this study was to observe and evaluate the value of red blood cell distribution width (RDW), neutrophil-to-lymphocyte ratio (NLR), and hemoglobin-to-red blood cell distribution width ratio (HRR) in the progression of NSCLC.

Methods: A total of 245 patients with NSCLC, 97 patients with benign pulmonary nodules, and 94 healthy volunteers were included in this study. Factors, such as age, gender, smoking history, histological type, lymph node metastasis, distant metastasis, TNM stage, and differentiation degree were statistically analyzed. The correlation of RDW, NLR, and HRR of patients with NSCLC with other clinical experimental parameters were also analyzed. Then, the diagnostic value of RDW, NLR, and HRR in the progression of NSCLC was evaluated.

Results: RDW, NLR, and HRR could be used to distinguish patients with NSCLC from healthy controls (p < 0.05). In addition, only the RDW in the NSCLC group with III-IV stage was significantly different from that in the benign pulmonary nodules group (p = 0.033), while NLR and HRR could significantly distinguish patients with NSCLC and benign pulmonary nodules (p < 0.001). RDW and NLR were positively correlated with NSCLC stage, whereas HRR was negatively correlated with NSCLC stage. RDW, NLR, and HRR were also significantly associated with the differentiation degree of NSCLC (p < 0.05). The ROC curve analysis showed that the combination of RDW with NLR, HRR, and CEA could show significantly higher diagnostic value than any one marker alone (AUC = 0.925, 95% CI: 0.897-0.954, and sensitivity and specificity of 79.60% and 93.60%, respectively).

Conclusion: RDW, NLR, and HRR can be utilized as simple and effective biomarkers for the diagnosis and evaluation of NSCLC progression.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Carcinoma, Non-Small-Cell Lung / blood
  • Carcinoma, Non-Small-Cell Lung / diagnosis
  • Carcinoma, Non-Small-Cell Lung / immunology*
  • Carcinoma, Non-Small-Cell Lung / pathology
  • Case-Control Studies
  • Cell Count
  • Disease Progression*
  • Erythrocytes / cytology*
  • Female
  • Hemoglobins / metabolism*
  • Humans
  • Lung Neoplasms / blood
  • Lung Neoplasms / diagnosis
  • Lung Neoplasms / immunology*
  • Lung Neoplasms / pathology
  • Lymphocytes / cytology*
  • Male
  • Middle Aged
  • Neutrophils / cytology*
  • Retrospective Studies

Substances

  • Hemoglobins

Grants and funding

Jin-liang Chen: the Natural Science Foundation of Jiangsu Province (BK20191207); Jin-nan Wu: Postgraduate Research & Practice Innovation Program of Jiangsu Province (SJCX19_0873); Dong-mei Zhang: the Scientific Research Project of Health Commission of Jiangsu Province (H2018035); the Scientific Research Project of “333 Project” in Jiangsu Province (BRA2018224); Jian-rong Chen: the Science and Technology Program of Nantong City (Grant No. HS2018002). Jin-liang Chen: Conceptualization, Methodology, Software, Investigation; Jin-nan Wu: Formal analysis, Data curation, Software, Investigation, Writing-Original draft preparation; Xue-dong Lv: Visualization, Investigation; Qi-chang Yang: Supervision; Dong-mei Zhang: Software, Validation; Jian-rong Chen: Project administration, Writing-Reviewing and Editing. The authors thank all the staff members in our institution.